Geoghegan Michael, McAuley Daniel, Eaton Simon, Powell-Tuck Jeremy
Department of Adult and Paediatric Gastroenterology, St Bartholomew's and the Royal London Hospital School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Curr Opin Crit Care. 2006 Apr;12(2):136-41. doi: 10.1097/01.ccx.0000216581.80051.d6.
Selenium is a trace element essential to human health. Critical illness is associated with the generation of oxygen free radicals resulting in a condition of oxidative stress. Supplementing critically ill patients with antioxidant nutrients may improve survival. Selenium levels can be low due to redistribution to high-priority organs and dilution associated with aggressive resuscitation of the patient. The purpose of this review is to investigate the benefit of selenium supplementation in critically ill patients.
Most of the selenium-supplementation trials were performed in relatively small patient populations presenting with trauma, sepsis, burns and adult respiratory distress syndrome. Widely varying doses of selenium of between 200 and 1000 microg were used, either alone or in combination with other antioxidants. Significant improvements have been demonstrated in length of hospital stay, rate of infection and need for haemodialysis in these patients. However, no trial has demonstrated a statistically significant improvement in mortality. Two recent meta-analyses suggest a trend towards reduced mortality with selenium supplementation.
Selenium, by supporting antioxidant function, may be associated with a reduction in mortality. To demonstrate this large, well-designed randomized trials are required.
硒是人体健康必需的微量元素。危重病与氧自由基的产生相关，可导致氧化应激状态。给危重病患者补充抗氧化营养素可能会提高生存率。由于硒重新分布到高优先级器官以及与患者积极复苏相关的稀释作用，硒水平可能会降低。本综述的目的是研究给危重病患者补充硒的益处。
大多数补充硒的试验是在患有创伤、脓毒症、烧伤和成人呼吸窘迫综合征的相对较小患者群体中进行的。使用了200至1000微克之间广泛不同剂量的硒，单独使用或与其他抗氧化剂联合使用。这些患者在住院时间、感染率和血液透析需求方面已显示出显著改善。然而，没有试验证明死亡率有统计学上的显著改善。最近的两项荟萃分析表明补充硒有降低死亡率的趋势。
硒通过支持抗氧化功能，可能与死亡率降低有关。要证明这一点，需要进行大规模、设计良好的随机试验。
